I’m not sure if it’s because VEDA has their upcoming Balance Awareness Week (September12-18), or if I am making an experiment of myself, but I’m going to whole-heartedly do VRT, again! Yes, again, after these many years! This time, though, I’m applying what I knew best, Occupational Therapy Based VRT. I’ve pulled out resources and this is my plan (do not do this yourself!), I look at my ADL’S or Activities of Daily Living, which simply put means, what do I do in my daily living (showering, housework, cooking, etc.). A great example would be the loading/unloading of my dishwasher. I have to visual scan what is in there and Motor Plan where and how to complete this task. I know I’ll get dizzy if my head inverts (upside-down), so I incorporate a squat to keep my head in a more neutral position. Raise up, turn body in the direction needed (still having trouble with quick head turns). I have to tilt and turn my head in putting away my dishes. It’s all done very ‘mindfully’, I really need to concentrate on the activity. I’m lucky, my kitchen is a Galley style (two sides facing each other), so there’s not much area to take a fall. I always think about my fall risks, as I’ve broken seven bones. Below, I’ve listed the areas an Occupational Therapist evaluates. As you can see, it does involve every area of one’s life, even Sexuality and Spirituality! At my worst, sexuality was the last thing on my mind, but on a good day…I continue with amazement with all Occupational Therapy entails. I’m giving you some insight, there are options with VRT.
*This is NOT for you to ‘treat’ yourself, it’s simply for a look at another side of VRT.
Appendix 3. Examples of Impact on Activities of Daily Living
*Eating: leaning across a table to pass something
*Bathing: bending to reach the legs, feet, perineal area, closing eyes to wash hair
*Toileting: bending to wipe, bending to pull garments up or down, maintaining balance while standing to urinate (males), twisting to reach toilet paper if behind toilet
*Transferring: sit-to-stand transfers from toilet, other seats
*Grooming and hygiene: bending the head forward to groom hair or brush teeth
*Taking medication: bending the head back to swallow medication
*Sexual activity: being in the superior position and weight shifting or moving the head rapidly; stability on water bed or other positioning furniture
*Sleep: head movements during sleep, changing sleeping positions, or maintaining the head in certain positions during sleep will elicit vertigo and cause waking, possibly nausea, and disequilibrium while groggy
*Instrumental Activities of Daily Living
Meal preparation, cleaning, other home management skills: Bending down, looking into high or low cabinets or shelves, and tasks that require repetitive head movements may all elicit symptoms. Task performance may be compromised or the task may be abandoned altogether.
*Gardening, yard work: Tasks may be performed less efficiently or abandoned; falls may occur on uneven ground.
*Vehicle care: Car washing and changing oil and filters may be difficult or impossible.
*Child, elder, and pet care: tasks that involve picking up and carrying loads, bending rapidly, performing or assisting in transfers, diaper changing, cleaning up messes on floor
*Community mobility: Driving will be more difficult, especially under conditions of reduced visibility, and may be abandoned or performed only for limited errands.
*Shopping: Navigating stores, carrying packages, bending to pick up items, scanning shelves for items will be more difficult and may be abandoned.
*Safety: ascending/descending fire escapes and stairs, dim areas with only emergency lighting
*Play, leisure, social participation, religious activities: Visual motion sensitivity, difficulty kneeling, navigating in crowds, vertigo elicited by repetitive head movements or bending the head down; activities and rituals may be severely restricted or abandoned.
*Work, either paid employment or volunteer jobs: Symptoms elicited by a wide range of tasks will cause reduced efficiency and sometimes total inability to per- form some jobs, depending on task demands.
Appendix 4. Examples of Performance Skills Affected by Vestibular Impairments
*Posture: Standing balance is impaired in most people with vestibular impairments. People may tilt the head and/or body off the vertical. They may have difficulty attaining and maintaining upright standing. This skill is particularly difficult when visual cues are absent or decreased. Static head and trunk posture while seated are sometimes impaired; dynamic sitting balance may also be impaired.
*Mobility: Mobility skills are manifested as veering toward one side while walking, ataxic gait, and falling or stumbling, particularly on uneven surfaces. Load compensation skills are impaired. Clients may need to use light touch to improve orientation and stability.
*Coordination: Dual-task performance skill is decreased.
*Energy: Routine tasks take more energy than usual, and endurance is decreased.
Appendix 5. Examples of Performance Patterns Affected by Vestibular Impairments
*Habits: Skill components of habits may be disrupted, and performance efficiency may be reduced, increasing the cognitive load and increasing the difficulty of performing habitual skills that were previously easy to perform (e.g., basic activities of daily living may have to be performed with modifications).
*Routines: Due to effects on performance skills, routines are less efficient and may need to be changed or abandoned altogether (e.g., hair washing may require supervision for safety and may take too long in the morning before work, so the client’s morning and evening routines may be changed).
*Roles: Some roles may be reduced or even abandoned, with consequent detrimental economic and psychosocial effects (e.g., clients with Ménierè’s disease may have to leave their jobs).
Appendix 6. Examples of Context Affected by Vestibular Impairments
*Physical: The physical environment may require modifications for safety (e.g., installing bathroom grab bars), or the home environment may require significant change (e.g., removing throw rugs, changing lighting patterns).
*Social: Misunderstanding of symptoms and problems by family, friends, and significant others may lead to hard feelings, reduced participation in socialization, changes in preferred social environments. These problems may occur due to decreased self-confidence, fear of falling, and a history of falls.
*Spiritual: Falls, vertigo, decreased concentration, and decreased ability in dual task performance, which all lead to decreased performance in vocational and vocational activities and decreased participation in the community, can cause decreased sense of self-worth, self-doubt, and decreased joy in life.
*Virtual: Visual motion sensitivity may lead to avoidance of virtual environments.
Appendix 7. Examples of Activity Demands Affected by Vestibular Impairments
*Timing: Tasks may take longer than before.
*Space demands: Lighting, flooring, and support surfaces may have to be changed.
*Social demands: Reduced social interaction per task may be required due to reduced tolerance for auditory and visual noise.
*Required bodily functions: Reduced function of vestibulo-ocular reflex, vestibulospinal reflex, and reduced spatial orientation skills all affect functional performance.
Appendix 8. Examples of Client Factors Affected by Vestibular Impairments
*Mental functions: reduced attention skills, reduced ability for dual task performance
*Sensory functions: reduced vestibular function, sometimes reduced auditory function
*Neuromuscular functions: reduced postural control, reduced dynamic visual acuity, impaired gait
*Vestibular labyrinth: In some instances, structural abnormalities in the physical labyrinth may be present, but these features cannot be observed; they may only be inferred.
*The American Journal of Occupational Therapy